Unfortunately, the HQO model for RARP did not adequately reflect parameter uncertainty, and no analysis was conducted to consider the potential costs associated with this uncertainty.
It follows that HQO's base case probabilistic analysis of RARP - which erroneously assumed that long-term outcomes were equivalent with certainty - underestimated the true uncertainty in the model results.
In any case, HQO was clearly justified in using CEA in its assessment of RARP, given the additional costs that RARP is expected to impose upon the health care system.
We agree with W&D that the 12 week time horizon adopted in the HQO model of RARP is inadequate for judging the value of a treatment for a long-term condition.
(2) The HQO analysis of RARP exemplifies some of these pitfalls.
Despite abundant observational data, for reasons of internal validity, the HQO clinical effectiveness review appropriately considers only the single published randomized controlled trial that showed minimal difference between RP and RARP.
The HQO report then describes an elegant original Markov model used to make a judgement about the economic attractiveness of RARP.